Monday, January 7, 2019

It is well documented that in addition to the core
symptoms of social/communication deficits and restricted repertoire of
behaviors, children with autism spectrum disorders (ASD) often experience other
comorbid (co-occurring) conditions. In fact, studies estimate that approximately
70 to 84 percent of children with ASD might meet the
criteria for a comorbid disorder or condition. Co-occurring conditions
include mental health (ADHD, anxiety, depression), neurological(seizure
disorder), physical(cerebral palsy, atypical gait), and medical (allergies,
asthma, gastrointestinal) conditions. In addition, unusual responses to sensory stimuli, chronic
sleepproblems, and low muscle tone can occur in individuals with
ASD.

Most parents have had some experience with a child
who has difficulty falling asleep; wakes up frequently during the night, and/or
only sleeps a few hours each night. Although temporary sleep difficulties are
an expected phase of child development, ongoing and persistent sleep
disturbances can have an adverse effect on the child, parents and other family
members. Indeed, a child’s sleeping problems can quickly become a daily
parenting challenge. Consequently, we should also expect that sleep problems in
children and adolescents with ASD will represent an additional burden on their families, as they attempt to deal with the challenges associated with
the symptoms of ASD.Moreover, there is
evidence to suggest that insomnia in itself can aggravate autistic symptoms and
further impair adaptability.

Children with ASD appear to experience sleep
disturbances more frequently and intensely than typically developing children. Previous population-based and retrospective clinical studies
have found a high rate of sleep onset problems in young children with ASD compared
to typically developing children. Between 44 and 86 percent of children
with autism have a serious problem with sleep. By comparison, between 10
and 16 percent of children in the general population have difficulty
sleeping. Research reports the following instances of sleep issues in children
with autism:

54%
displayed resistance to bedtime

56% experienced
insomnia

53%
suffered from parasomnias, such as sleepwalking or night terrors

25%
experienced sleep-disordered breathing, including sleep apnea

45% had
difficulty waking up in the morning

31% experienced
daytime sleepiness

Research

Emotional and behavioral problems are related
to sleep problems in the general child population, and have also been associated
with sleep problems in children with ASD. For example, a previous study of
children with Asperger syndrome or high-functioning autism found that those
with chronic insomnia were characterized by more emotional and
behavioral symptoms than their peers. Co-occurringconditions, such
as gastrointestinal (GI) problems, sensory sensitivities, attention deficit
hyperactivity disorder (ADHD) and anxiety are also known to disrupt sleep. Although research suggests that children
with ASD have a high rate of sleep problems, even when adjusted for other
mental health problems, the lack of longitudinal data
and population based studies has limited our ability to understand the complex
relationship between co-occurring emotional and behavioral problems and sleep
difficulties in this group of children. In order to examine the need for
increased sleep health care in children with ASD, sleep problems should be
longitudinally studied in a total population setting. This approach allows
researchers to examine potential risk factors and assess the development of
sleep problems over time, as well as plan for early prevention and
identification.

A longitudinally-based
study published in the journal Autismexamined the prevalence and chronicity of sleep problems in children with
problems believed to be typical of ASD. The children were assessed for autistic symptoms, sleep problems,
and emotional and behavioral problems. Overall, the frequency of chronic insomnia was more than ten times higher in autistic children
compared to non-autistic children (39.3% v 3.6%). These children also developed
more sleep problems over time, with an incidence rate at of 37.5% compared
to 8.6% in the controls at age 11-13 years. Likewise, sleep problems were more
persistent over time in children with autistic symptomatology, with a remission
rate of only 8.3% compared to 52.4% in the control group. Despite few girls
being represented in the study, sleep problems were
significantly less prevalent in girls than boys, and that their sleep problems
were also more transient. The presence of comorbid attention-deficit/hyperactivity disorder (ADHD) was a strong and independent risk factor for sleep problems in
the ASD group. While emotional and behavioral
problems explained a large proportion of the association between sleep problems
and autism, children with autistic symptoms had a three-fold increased risk of
sleep problems.

Implications

Previous research and results of this longitudinal population-based
study show a clear association between autism symptoms and sleep problems and support the generally high prevalence rates of sleep problems reported in children with autism. Research also suggests that sleep disturbances may
represent early warning signs of autism, exacerbate autism symptoms severity,
significantly decrease the health-related quality of life of individuals with
ASD, and affect the mental health of family members. Problematically, sleep problems tend to exacerbate other issues characteristic of the ASD. For example, daytime sleepiness from lack of sleep often results in more severe repetitive behavior, hyperactivity, inattentiveness, and aggression during the day as well as deficits in higher-order and complex cognitive
functions. This argues for the assessment and treatment of sleeping problems as a
standard and integrated part of the symptom management of ASD. Diagnosing
and treating sleeping problems in autistic children is important both to relieve
symptom severity and improve quality of life for children and their
families.

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